Improving planned orthopaedic surgery for adults in north central We are proposing changes to how adults have surgery for bones, joints and muscles (planned orthopaedic surgery). This includes hip and knee replacements; and other surgery to hips, knees, shoulders, elbows, feet, ankles and hands.

Closing date for feedback: 6 April 2020 About this consultation Why we need to make changes We are looking at how we provide planned orthopaedic Over 1.5 million people live in north central London and this number is surgery for adults in Barnet, Camden, Enfield, Haringey and expected to rise. The demand for healthcare is increasing and this will impact particularly on planned orthopaedic surgery. While many of these services are Islington (north central London) and we would like your views of good quality we know that patients’ experiences vary and could be better on our proposals. and that demand is forecast to increase. This summary explains our proposals to meet the current Waiting lists are too long challenges we face in providing planned orthopaedic surgery • In January 2019, over 10,500 residents in north central London were across north central London. We are asking for your views on waiting for planned orthopaedic surgery. our proposals, before we make a decision. We would also like • Between January 2018 and January 2019 only 79% of patients referred to hear if you have alternative proposals, and what they are. for orthopaedic surgery in north central London started treatment within A full consultation document and further information 18 weeks; in some of our , this fell as low as 65% in the winter months is available at: www.northlondonpartners.org.uk/orth_consultation Too many operations are cancelled • In 2018/19 across north central London, 530 orthopaedic operations were cancelled – 96% of these operations were cancelled on the day of surgery. What is planned orthopaedic surgery? This equates to 10 cancellations a week. This was due to the demands of Orthopaedic surgery treats damage to bones, joints, ligaments, tendons, emergency services, lack of available beds or staff. muscles and nerves (the musculoskeletal system). Patients may be referred to Demand for planned orthopaedic surgery is increasing an orthopaedic surgeon for a long-term condition that has developed over many years, such as osteoarthritis or other non-emergency damage. • The demand for planned orthopaedic surgery is expected to increase by around 9.5% by 2029. Hip and knee replacements are the most common orthopaedic surgery offered in the NHS, followed by other surgery of hips, knees, shoulders, Without change, it is unlikely that local hospitals would be able to reduce elbows, feet, ankles and hands. waiting lists; the number of cancellations would continue to grow; and we would not be well-prepared to deal with the expected increase in demand for Planned surgery is when patients have an appointment booked in services. If our proposals were approved, the NHS would continue to spend advance. It is planned treatment, following a referral to by a GP the same amount of money (around £37 million) on orthopaedic services, and an assessment by specialists. It is sometimes called ‘elective’ or ‘non- however we could make much better use of this money and improve care. emergency’ care. Over time, this new way of working is expected to save money. All the NHS hospital trusts who would deliver planned orthopaedic care under these proposals have been part of developing them. We are proposing a new way to organise Our ambition planned orthopaedic surgery for adults in There are a number of benefits of organising care differently: • Access to consistently high-quality care for all patients across north north central London central London Two partnerships for planned orthopaedic care have been formed by local • Being able to meet current and future demand for services NHS hospital trusts – with University College London Hospitals (UCLH) and Whittington Health working together, and The Royal Free London Group • Physically separating emergency and planned surgery, to avoid (Royal Free, Barnet Hospital, Chase Farm Hospital) working with North last-minute cancellations Middlesex University Hospital (North Mid). • Highly-specialist staff who focus on high-volume orthopaedic surgery, and If the proposal is agreed, these partnerships could deliver real improvements become increasingly skilled at carrying it out in how we provide this care. In the future we want to ensure that patients can access high-quality planned • Two NHS hospitals with dedicated operating theatres and beds, for patients orthopaedic surgery without the risk of cancellation, in a timely manner. who need to stay overnight after their operation – Chase Farm Hospital and University College London Hospital • A choice of NHS hospitals for those needing day surgery The challenges • A choice of NHS hospitals for outpatient appointments We know that with any change there may be disadvantages for some people: • Improved education classes for patients to help them understand their operation and what to do to support their recovery • Some patients may have to travel further on the day of their operation • Appointments with a named surgeon and their surgical team, who would • Visitors may have to travel further stay with patients throughout their care, regardless of where it takes place • Some staff may have to work in a different hospital to where they usually • Rehabilitation support for patients after their surgery work, on some days of the week • Access to high dependency or intensive care units for patients needing • People with additional needs (such as those with a learning disability, additional care after their surgery or dementia) could find it confusing to go to a hospital they are not • Care coordinators to support patients with conditions such as dementia or familiar with. a learning disability to understand their care and where it might take place A list of benefits and challenges can be found in our consultation document. • More complex surgery would continue at the Royal National Orthopaedic We would like to hear your views on these during our consultation. Hospital, a super-specialist centre • Patients with other complex medical conditions, such as haemophilia, will have their surgery at the hospital which specialises in their condition • Emergency orthopaedic care would continue at all local hospitals with an accident and emergency department. What do the changes mean for patients? Where patients have care today The proposed change could affect anyone living in our five boroughs, and a small number in neighbouring areas, who might need a planned orthopaedic operation in the future. To help us in our decision-making, we’d like feedback from anyone with experience of, or an interest in, these services. Under our proposals all patients could experience a significant improvement in their care, To achieve this, some patients would have surgery in a different hospital in future, when compared with current arrangements. Around 11,000 patients currently have planned orthopaedic surgery each year across OUTPATIENT DAY SURGERY OVERNIGHT STAY 10 NHS and private hospitals. Under our proposals, 1460 patients would have their day surgery at a Barnet Hospital Chase Farm Chase Farm different hospital when compared to current arrangements and around 1360 patients who need an overnight stay for their surgery (such as hip and knee Chase Farm Chase Farm surgery) would have their surgery at a different hospital when compared to current arrangements.* Chase Farm Hospital Chase Farm Chase Farm With the help of their GP or physiotherapist, patients would choose one of the two partnerships for their planned orthopaedic care. The choice of North Mid North Mid North Mid partnership would determine their choice of hospital for outpatient care and where they would have their surgery. UCLH UCLH UCLH

Whittington Health Whittington Health Whittington Health

Private hospitals Private hospitals Private hospitals

*This includes patients who currently have NHS care in a private hospital North Middlesex University Where patients go for care today vs Hospital / Royal Free London Partnership where they could go under our proposals UCLH / Whittington Health Partnership

Today HERTFORDSHIRE In the future

The Kings Oak Hospital Chase Farm Hospital Chase Farm Hospital

The Cavell Hospital Barnet Hospital ENFIELD SSC ENFIELD Royal National Royal National Orthopaedic Hospital Orthopaedic Hospital North North Middlesex Middlesex University University Hospital Hospital BARNET BARNET

Highgate HARINGEY WALTHAM HARINGEY HARROW Private FOREST Hospital

HACKNEY Whittington Whittington Royal Hospital Hospital Free Hospital BRENT CAMDEN Royal Free Hospital ISLINGTON Outpatient CAMDEN ISLINGTON appointment

UCLH Day surgery UCLH Overnight stay National Hospital for Neurology and Neurosurgery SSC Super Specialist WESTMINSTER Centre In the future, patients will have a choice of the two partnerships for their care. The following table shows where patients could go for different elements of their care. Planned orthopaedic services today vs services under our proposals Overnight stay: Usually hip & knee surgery The table below shows the difference between the orthopaedic care available in north central London today, next to how it would look if these proposals P P were implemented.

P UPN SURR FLLW UP CMMUN Not available Available in some hospitals CMMUN PPNMNS PSPR CRE CR Available in the new arrangements Barnet Barnet Hospital Hospital In the Chase Farm Chase Farm Chase Farm Today North Mid North Mid proposals Royal Free Royal Free London London Hospitals carrying out larger numbers of Outpatient orthopaedic operations provide higher quality UCLH UCLH UCLH appointment care for patients Whittington Whittington Health Health Overnight stay Ring-fenced operating theatres, wards and specialist staff, separate from A&E departments, minimises cancellations and leads to better care Day surgery: Usually shoulder, hand and foot surgery Teams that carry out surgery six or seven days a week reduces waiting lists and makes maximum P P use of facilities High dependency or intensive care units and P UPN SURR FLLW UP CMMUN CMMUN PPNMNS PSPR overnight senior medical cover provides support CRE CR for patients who have complications Barnet Barnet Hospital Hospital Care coordinators to offer support to patients Chase Farm Chase Farm Chase Farm with conditions such as learning disabilities and North Mid North Mid North Mid dementia Royal Free Royal Free London London Consistent education classes before surgery and Outpatient UCLH UCLH UCLH appointment high-quality rehabilitation ensures the same Whittington Whittington Whittington high-quality care, in all hospitals Day surgery Health Health Health

Visit our website to read more evidence of why these features offer North Middlesex University Hospital / UCLH / Whittington improvements for patients Royal Free London Partnership Health Partnership How our proposals were developed How to give your views Our proposals were developed in an innovative, collaborative way between We want to receive the views of as many patients, public, staff and partners the providers of health services in north central London, drawing on the as possible to inform our plans during our public consultation. This includes feedback from clinicians, NHS Trusts, local patients, stakeholders, and a residents of Barnet, Camden, Enfield, Haringey, Islington and neighbouring number of workshops with all of these groups participating. areas who might use hospital services in north central London. We are particularly interested in hearing from anyone who is currently having or has Our proposals were also reviewed by the London Clinical Senate, a panel of had experience of planned orthopaedic surgery, anyone who might need NHS professionals, patients and other groups. They agreed that there was a these services in future and their families and carers. “clear case for change, based on national best practice and consideration of the local issues”. By inviting people to take part in the consultation we want to understand whether we have developed the best possible solution to the current Some of the things that patients said were important were included in challenges, how proposals could be further improved and if there are the proposals: alternative proposals we haven’t considered. • Care coordinators to support patients with conditions such as dementia All feedback will be evaluated by an independent company, Participate Ltd. and learning disabilities A full consultation document is available at: www.northlondonpartners.org. • Joining up their digital patient records securely so that information can be uk/orth_consultation shared more easily Please let us know your comments and views on these proposals by: • A full travel and transport analysis to help us understand the impact of our proposals and develop ways to minimise any down-sides. 1) Completing the printed consultation questionnaire and returning it in the post using the Freepost address provided. • Patients would always have choice of where they have their care; this is part of the NHS constitution. 2) Completing the consultation questions using our online survey at: www.northlondonpartners.org.uk/orth_consultation • We asked specialists in emergency care to look carefully at our plans and confirm that our plans would not undermine emergency care 3) Writing to us at: FREEPOST NLP ORTH CONSULTATION (No need for a stamp or postcode) More information can be found on our website at: 4) Invite the programme team to speak to your group using the contact www.northlondonpartners.org.uk/orth_consultation details below 5) Give your feedback on the phone by calling Freephone: 0808 1567192

“For me, it was important that those who find it difficult to use NHS services were considered.” Helen Andrews, patient representative 6) Attending a public meeting during the consultation period. Full details Additional help to respond to these proposals is available on request: of these can be found on our website. If you attend any of the public meetings or drop-in events, your views will also be captured at these. We can provide support for those who may need Barnet: Monday 2 March, 6.30pm some additional help to participate. We also offer [venue to be added here] versions of this consultation document in large print, Camden: Tuesday 10 March, 6.30pm* Easy-Read or Braille on request. Once produced, these [venue to be added here] will also be available on our website. Enfield: Saturday 14 March, 10am* [venue to be added here] We can also offer translations and additional support if English is not your first language. Haringey: Wednesday 18 March, 6.30pm [venue to be added here] Please contact us on the details below if you need additional help to participate or would like to give feedback verbally Islington: Saturday 21 March, 10am [venue to be added here] Email: [email protected] *Events in Camden and Enfield will have a BSL interpreter available. Interpreters can be booked on request for all other events.

In addition to these events, Trusts, Healthwatch and voluntary sector Phone: Freephone: 0808 1567192 organisations are also planning and promoting opportunities to participate. Please check our website, which will be updated throughout the consultation period. www.northlondonpartners.org.uk/orth_consultation Mail to: FREEPOST NLP ORTH CONSULTATION (No need for a stamp or postcode)

Scan for questionnaire Responses to the consultation will be independently evaluated by Participate, who will share their report with decision-makers. • In May 2020, stakeholders will have the opportunity to comment on the draft evaluation together with the review of the equalities impact assessment • In June 2020 the evaluation of responses, feedback from stakeholders and impact assessments will be shared with the Joint Health Overview and Scrutiny Committee (JHOSC). A decision-making business case (DMBC) will then be developed outlining the recommended decision • In June/July 2020 patients and NCL CCG will have the opportunity to review the evaluation together and discuss any implications. The final DMBC presented to NCL CCG for decision The final decision and the outcome of the consultation will be promoted widely, and we will continue to involve local residents as we implement any agreed changes. We will monitor waiting times, cancellations, readmission rates, how long patients spend in hospital, Friends and Family test results and other measures to ensure that any changes implemented have been effective.

This consultation is being coordinated by North London Partners in health and care. The organisations consulting with local residents are Barnet, Camden, Enfield, Haringey and Islington clinical commissioning groups. On 1 April 2020, these five CCGs will merge to become North Central London CCG.